Tereberg: Governor should go for Medicaid expansion

This is an archived article that was published on sltrib.com in 2013, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

I have been a health care professional for more than 40 years, from the bedside to management and consulting, from private health care to managed care to military care.

Over these years, the problems of escalating costs, and providing basic health care services to the uninsured, underinsured and various disenfranchised members of our society, have been debated ad infinitum.

Attempts to control health care cost through a variety of market-driven schemes or regulatory constraints have made little, if any, impact on the cost of care.

The plight of the uninsured continues as well. Today, if you are uninsured and do not fall into one of the eligibility categories mentioned above, your option is the emergency room or a handful of community clinics where the range of services is limited. Finding a doctor who will provide free care  well, good luck.

Clearly, there are health care practitioners at all levels who make significant contributions to people who are without the means to pay for those services through the community clinics and some private practices.

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Yet, in no way can charity be expected to provide the full array of services needed to cover the uncompensated care needs in our society, or ensure continuity of care for the uninsured, chronically ill folks in our communities.

Furthermore, if charity care were a workable solution, it would have solved the health care access problems by now. The cost of care of the uninsured is passed on to your neighbor, and the society at large, through higher insurance premiums (estimate at $1,000 per year, according to Utah Health Policy Project) and higher charges when you access the health care system. This is cost shifting, not cost control.

With the passage of HB391, thankfully amended to allow consideration of expanding the eligibility of Medicaid in Utah, it is now up to Gov. Gary Herbert to decide on the future of the health care options of our uninsured citizens.

Medicaid eligibility "expansion" is unlikely to increase Utah's overall cost of health care to taxpayers, and Utah's health care issues are not likely to change significantly.

By establishing stable funding through Medicaid, we are able to provide access to primary care services, which would shift care from expensive, uncoordinated emergency care to much less costly outpatient services.

At the same time, payment for the care provided in our acute facilities will not have to be buried in increased hospital costs, nor shifted to private insurance.

The aversion of many of our legislators to accepting federal funding seems disingenuous. Those federal dollars (about $5 billion over three years) come from the taxes paid by each of us. So, why would we refuse money, much of which was ours in the first place?

Other concerns expressed by opponents of Medicaid expansion are based on the unfounded fear that the federal government will renege on its promise to continue Medicaid funding after the initial three-year implementation that is entirely federally funded. After that, the government pays 90 percent of the cost and the state 10 percent.

The federal government has not failed to meets its current 70 percent contribution to Utah's Medicaid program since the program's inception in 1965.

As the governor considers whether to approve expansion of Medicaid eligibility to include all Utahns, I hope he hears the multitude of voices that advocate in favor of the expansion  organizations, professionals and citizens whose lives and/or work lend credence to their support.

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